Provider Demographics
NPI:1699075184
Name:PODESTA, MARCELO ALBERTO (LMFT)
Entity type:Individual
Prefix:MR
First Name:MARCELO
Middle Name:ALBERTO
Last Name:PODESTA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7317 EL CAJON BLVD # 230
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7434
Mailing Address - Country:US
Mailing Address - Phone:619-653-6900
Mailing Address - Fax:
Practice Address - Street 1:7317 EL CAJON BLVD UNIT 230
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7434
Practice Address - Country:US
Practice Address - Phone:619-653-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 77776106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist